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Bob was an experienced firefighter. He worked for 17 years as a member of his city’s fire suppression team working his way up to fire captain. After 5 years as captain, Bob decided to transition to the role of fire training officer where he could work five 8-hour shifts per week instead of 24 hour shifts. Bob and four other training officers were responsible for developing, delivering and supervising the training activities of more than 200 firefighters in his department.

It was a sunny, unseasonably warm October day and Bob was excited to be back at work after being on medical leave. A month earlier he underwent a routine surgery and had spent the past few weeks recovering. This would be the first of two, generally routine, trainings—Bob had worked as a training officer for 6 years now and prepared nearly 600 of these trainings over his career. This particular training would involve exercises using a smoke simulant to train the firefighters on proper fire-attack and victim rescue techniques. A fog machine would create low visibility inside the 3-story cinder block training tower, which had rooms set up to resemble a kitchen, bedroom, and office.

Before the training began, Bob refilled the fog machine reservoirs, checked hose lines, opened valves, checked fluid levels, and turned on the built-in fogging system and portable fog machines that could be operated remotely from a nearby classroom. In one room he had to make some adjustments to the supply nozzle of the smoke simulant. Bob usually had an N95 respirator with him, but he left it back in the office. “I’ll be in and out of the room in a few seconds,” he thought to himself.

The exercise also was going to involve propane-generated heat and fire, so once the smoke was set, Bob also preheated some of the rooms to 400ºF–425ºF. Once the exercise started, Bob briefly poked his head in a training room to check the progress of the smoke, heat, and fire. Everything was looking good.

Once the exercises were complete, Bob and his fellow trainers opened doors and windows inside the tower and turned off equipment while an exhaust system in the tower was turned on remotely to clear the tower of smoke simulant and heat. Shortly thereafter Bob started to experience chest pain, shortness of breath, and a cough that produced a small amount of blood. Bob immediately knew from his first responder training that he had to go to the emergency room.

At the hospital Bob explained his symptoms to the doctor and told him how it was his first day back at work following his surgery. That, along with the chest pain, immediately made the doctor think this could be a pulmonary embolism and he immediately ordered a test to see if Bob might have a blood clot in his lungs. The doctor didn’t see a clot, but did see small spots in his lungs.

Bob was relieved he didn’t have a blood clot because he knew how serious that could be, but what he saw on the x-ray concerned him.

What do think Bob is suffering from? Share your ideas in the comments and stay tuned for the next edition.

Stephanie Stevens, MA, is a Health Communication Specialist in the NIOSH Office of the Director.

This blog is part of the NIOSH Workplace Medical Mystery Series. The names and certain personal details of the characters are fictitious and do not represent an actual person or persons.

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SOUNDS LIKE THE COMBINATION OF HEAT, SMOKE SIMULANT AND COMBUSTION FROM CINDER BLOCKS BEING BREATHED IN-AND IT BURNED HIS LUNGS- MUST HAVE THOUGHT SOME TYPE OF PARTICULATE MATTER LIKELY OR WHY ELSE WOULD HE NORMALLY WEAR AN N 95-?????

The “fake smoke” contains mineral oil mist, diethylene glycol, formaldehyde, and acrolein that can be well above permitted exposure limits, even for a few minutes. Prolonged exposure over a career can certainly result in serious lung/respiratory illnesses.

PPE must be enforced for all personnel who may be exposed, especially for trainers who have a higher/longer exposure rate than the firefighters coming through on an annual basis (or so).

A reaction to inhaling theatrical smoke? it’s a liquid chemical that is changed to “smoke” – or a vapor – through a heating process. A chemical nonetheless. It’s advertised as “harmless” but anytime you inhale a chemical, there has to be a reaction. The surgery may be coincidental or it may have triggered a decrease in immune function (caused by the body trying to heal itself). He’s been breathing the stuff for six years. I also use theatrical smoke and don’t bother with an N95 or SCBA. I may be changing my outlook based on the results. I’m waiting with bated breath, pun intended.

The small mist particles in this case caused a sever reaction. The spots in the lungs are similar to how Hypersensitivity Pneumonitis presents in a immune reaction but that would require previous exposures. Could the patient have had other exposures to this fogging mist?

tuberculosis- unrelated to potential recent inhaled gases. other possibility is a non-tuberculous mycobacteria such as MAI, especially if he has underlying lung damage from smoke inhalation as a firefighter

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